Second Cancers and Residual Disease in Patients Treated for Gastric Mucosa-Associated Lymphoid Tissue Lymphoma by Helicobacter pylori Eradication and Followed for 10 Years
Mené en Allemagne sur 120 patients atteints d'un lymphome du tissu lymphoïde associé à la muqueuse gastrique et ayant reçu un traitement pour éradiquer la bactérie Helicobacter pylori (durée médiane de suivi :10 ans), cet essai prospectif multicentrique évalue, du point de vue de la rémission complète et de la présence de cellules tumorales résiduelles, les résultats cliniques à long terme, puis compare l'incidence d'un second cancer parmi ces patients à celle mesurée dans la population générale
Cure of Helicobacter pylori infection induces remission in most patients with gastric mucosa-associated lymphoid tissue lymphoma (GML) that is associated with these bacteria. We determined the long-term outcomes of these patients a prospective multicenter trial, and investigated whether they developed second cancers or had histologic residual disease. We followed 120 patients with stage EI1 GML for a median of 122 months after H pyorli eradication (range, 1–171 months). Remission was determined by histology analysis and development of second cancers was documented. Of the patients, 80% (96/120) achieved complete remission from GML, with 80% of those (77/96) remained disease free. The estimated mean survival time in the Kaplan-Meier analysis was 147 months (95% confidence interval [CI], 138–156 months). Of the patients that achieved complete remission, 17% (16/96) had histologic residual disease after a median of 32 months (range, 3–68 months). Disease did not progress in any of these patients, and all but 1 achieved a second complete remission (median duration, 46 months). Standardized morbidity ratios revealed a significantly higher incidence of gastric cancer (8.567; 95% CI, 3.566–20.582) or non-Hodgkin lymphoma (NHL)(18.621; 95% CI, 8.365–41.448) in the 96 patients that achieved a complete remission, compared with the general German population. Cure of H pylori infection leads to continuous complete remission in most patients with H pylori -associated GML. Patients with histologic residual disease should be followed, because they are at risk for development of secondary (gastric and NHL) cancers.
http://linkinghub.elsevier.com/retrieve/pii/S0016508512009249?showall=true